Provider Demographics
NPI:1023170586
Name:BACH, GAIL S (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:S
Last Name:BACH
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W 80TH ST APT 1C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-7050
Mailing Address - Country:US
Mailing Address - Phone:212-874-2857
Mailing Address - Fax:
Practice Address - Street 1:209 W 80TH ST APT 1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-7050
Practice Address - Country:US
Practice Address - Phone:212-874-2857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR020388-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPR020388-1OtherLICENSE NUMBER NEW YORK S